Provider Demographics
NPI:1881365849
Name:STEFANOVA, VENERA N (RDH)
Entity type:Individual
Prefix:
First Name:VENERA
Middle Name:N
Last Name:STEFANOVA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 NE CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8068
Mailing Address - Country:US
Mailing Address - Phone:507-459-7288
Mailing Address - Fax:206-745-3811
Practice Address - Street 1:2235 NE CASTLE DR
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8068
Practice Address - Country:US
Practice Address - Phone:206-745-3808
Practice Address - Fax:206-745-3811
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60348846124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist